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<br /> Industry Services Division {/ uv' AQYl
<br /> r3r�0$ 1 . 1400 E Washington Ave Snniaryhsmil Nonlxr(to be lillul In el Co]
<br /> P O. Box 716211
<br /> \<;PS r Madison,W153707-7162 5-koV7
<br /> IV-06
<br /> Sanitary Permit Application siteT—...non N"mher
<br /> 1.aaandi ah its 383 2 1,2) rn, Aran cod,sithrin—on of I-Iterrin it,tire aplanapriab-Tocnaliencil nail
<br /> n - Note 7/ 1/7/
<br /> is earned w obLn g _amainM DL Apirl2minf side- cared Pi IT are sohnLalw PmJectZilodn
<br /> r tho. iinddressl I.
<br /> ,he a l t t I side,fd l al S al art - n,Pm°ia he,1111 for zrfar do v
<br /> o.ance..rn nt,Irma Iaw., is wuxm.scar. v. /Baas /K /7e) 17L412-)
<br /> 1. Application Information—Please Print.\Il lnfonnation
<br /> i Owner's Nam, Parcel i -39-/6-10-5
<br /> Zob rrf a�.fe.. "y�o�-01(l0(
<br /> PmpenY Ovate, that Addy... Pm"ns,Location
<br /> Y'i v Fran on l 4"e Go,t.I it
<br /> Ce"Stme I /:"cone Phone Nmnher 5Ev,. SW 1i5eenen "6
<br /> ileaa,s r.. {,r, t G/d H/& 57/ 3 (Leato on
<br /> 1 35 N:. R_!& F.nrp�
<br /> 11.'1's IT of Ber i ld i rig(cheek all that apps) Imp
<br /> Dd I ort Family Do elIii—Nun bet of Bedrooms ....v4 Sulxliv¢,on Nano
<br /> Hlo,k p
<br /> ❑Puhis,'Co,nani—D,,xTribe Use D Car,It
<br /> ❑Star,O'bed-1)...arl,Use SM boarder ❑ Villagcof
<br /> (klbwn uf_�<TNer
<br /> Ill. 1cipd of Permit (Cheek only one bac on line A. Complete line 11 if applicahte)
<br /> A' N...Is ❑ lA'lI-nonrTaTunion,,llnldiag'I ank Reldocenent Oda D Other Vedification to Exideast S_ran datilip)
<br /> IS. ❑ Pato:,lr--d OPmnhltevrslnn ❑Chane of Planer. D Penni,Tmnsfa'm New List l'rcvinu,Pcmfv Numberand Dat,Issued
<br /> Before Fspintion 0,—
<br /> id. ra
<br /> xmcrid.'ry Iry of PONTS ss denecau onent/Denlee: (Ch,ck all that a r rM19
<br /> ❑ Non-Rtsuubed It,Ground ❑ PTII, eIooGround ❑ Ar-0mde ® Dlound 124 inof,uimble and D Donna<Pd in.of ss,iriblusoil
<br /> ❑ Holding Ick D Other Dap.rcnl Compoa,nr v,,hin) ❑Prerrc:umenr Owi„(,nplviill
<br /> V.Itis rersaVrrearm out Area Information:
<br /> Design flow(gird) I Dian Soil AV'licminn Itnrefg'd,p D..Penul Area IlaP,irnl(0) Ul,Pe 31 dna hbpso'd rap Svsrrnt Fl,waion
<br /> m0 `7 300 3-,! r,
<br /> VI.Tank Infer C" iryin 'rural pot Dnnufcmmr
<br /> Oellnns Gallons Units
<br /> e,Ineks F.+lu g1an6 — — IT
<br /> Veptic lloWnF or iTook 73� 7577
<br /> IbruRC hanlu`r f Q 3e� i
<br /> VII.Responsihilitr Sbn,ment- 1,the aml,rsi•nm,asamne respnn,ihiLr.for installation of the P(1N'I'Ihm n rhe:ma,e d Nan,.
<br /> Planber's Nam,l h t) I'ImnbdsSia tum SIP/bIYRh-Numher F3usiruss Phone Number
<br /> Hari Address(Strcer Cay,state.7o Code)
<br /> A7760 � 3,5— Gtl. S5
<br /> VIII.County/De tort meat Ilse Only
<br /> .SP'mvd ❑ ITisa'pn ed P,mtit F¢ Uae lnsuM Ixs ing rAgan Slannmre
<br /> n
<br /> ❑ownerci,en Rednon for Denial 37SOd ?/./y_/y
<br /> I X.Conditions of App rot,ab Reasons for Disappruvnl /
<br /> J rode✓ (tnC (,/oS {(GfGI/fSGI� 5/011 �p2
<br /> YY plai fin sofa/c ho.�orrseG i{ .twnrr. I D E((�I�J('�ISIVE
<br /> duan in m,n or,,,rtm,an no,oa—one aaendr m me Cantor only nn inure.none,.man N,u,11 ine MAN 14 IU14
<br /> 651//!-o!o
<br /> SBD-61"(80313) BURNETf COUNTY
<br /> ZONING
<br />
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